Dr Atul Gawande, Better: A Surgeon’s Notes on Performance

In the absence of certainty, the truth is we want doctors who fight. Through a friend, I met Watson Bowes Jr., a nationally known professor of obstetrics, now emeritus, from the University of North Carolina. We got talking and I asked him what he was most proud of in his career. I expected to hear about laboratory discoveries or obstetric techniques. He had done foundational research on how oxygen is carried to the fetus, and he had been among the first in America to learn how to give blood transfusions to fetuses. But what made him most proud, he told me, was an experiment he had done as a young obstetrician at the University of Colorado in 1975. At that time, babies born two months prematurely or more were considered to have almost no chance to survive. Little, therefore, was done for them. For one year, however, he decided to treat those babies as if they would live – no matter how blue, how weak, how small. The doctors on his team used no new technologies. They simply did everything they would normally do for a full-term baby. If the baby had trouble in delivery, they did a C-section, when before they would have spared a mother the surgery for such a hopeless child. They used fetal heart monitors when they usually wouldn’t have. They put in intravenous lines and placed the babies on respirators, however limp and lifeless they seemed. And they discovered that the vast majority of these premature babies, babies only two or three pounds in size, could survive to be normal and healthy – just by the doctors’ fighting for them.

Even when we don’t know that a patient can be completely normal and healthy, we want doctors to fight. Consider again the wars in Iraq and Afghanistan, where military surgeons have learned how to save soldiers who have never been saved before- soldiers with almost a hundred percent of their bodies burned, soldiers with severe and permanent head injuries, soldiers who have had abdominal injuries and three limbs blown away. We have no idea whether it is possible to live a good life with no arms and only one leg, but we don’t want the doctors to give up. Instead, we want them to consider it their task to learn how to rehabilitate survivors despite the unprecedented severity of their injuries. We want doctors to push and find a way.

We also want doctors to fight even in the most mundane of situations. My ten-year-old daughter, Hattie, has had to deal with severe psoriasis for a long time. It is hardly life-threatening. But the condition has left her with thick red itchy and scaling patches all over – on her knees, her back, her scalp, her face. The dermatologist tried stronger and stronger steroid creams and medications. These damped the disease down somewhat, but only some of the angry patches went away. This was about as good as we could do for her, he said. We would just try to control the disease and hope Hattie outgrew it. So for a long while we lived with her condition. But she hated it, and she hated the eruptions on her face most of all. She kept asking her mother and me, “Please just take me to another doctor.” So finally we did. The second dermatologist said she had something else she wanted to try. She put Hattie on amoxicillin, an ordinary antibiotic. It doesn’t work in adults, she said, but sometimes it does in kids. In two weeks, the patches were gone.

The seemingly easiest and most sensible rule for a doctor to follow is: Always Fight. Always look for what more you could do. I am sympathetic to this rule. It gives us our best chance of avoiding the worst error of all – giving up on someone we could have helped.

…In a way, our task is to “Always Fight.” But our fight is not always to do more. It is to do right by our patients, even though what is right is not always clear.

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George Pólya 
❝ There was a seminar for advanced students in Zürich that I was teaching and von Neumann was in the class. I came to a certain theorem, and I said it is not proved and it may be difficult. Von Neumann didn’t say anything but after five minutes he raised his hand. When I called on him he went to the blackboard and proceeded to write down the proof. After that I was afraid of von Neumann. ❞

borgiese:

Alicia Vikander by Benoit Peverelli for Numero China, September 2013 

Euripides  (via petrichour)
❝ I am nothing but words,
      just a shape
              of dreams or night. ❞
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    (via megalong)

Emma Stone at the screening of 99 Homes at the Venice Film Festival, Aug. 29th

englishsnow:

 Becca Gilgan

…until the hovering, curious dominant of their separate lives should resolve into a tonic of darkness and the final absence of all motion.

brightestofcentaurus:

Seven Sisters: Pleiades

The Seven Sisters, also called the Pleiades or M45, is an open star cluster located about 400 light years away towards the constellation Taurus. It is about 13 light years across and is one of the brightest and closest star clusters to us.

The cluster contains over 3000 stars, most of which are considered middle aged. Surrounding the brighter stars are reflection nebulae, gas and dust reflecting the light from the stars. Also buried in the cluster are faint, low mass brown dwarf stars.

Image from National Geographic, information from NASA.

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